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Summer Sessions 2013 Graduate Registration Form

To register, complete this form and click the "SUBMIT" button below, or print out the form and mail it to:

Graduate Studies Office
Clarke University
1550 Clarke Drive
Dubuque, Iowa, 52001-3198

If you have any questions call (563)588-6635.

Last Name:
First Name:
Middle:
Please indicate if you were previously registered at Clarke under a different name.
Formerly:
Date of Birth:
(The graduate studies office will contact you for your social security number.)
Permanent Home Address
Street:
City:
State:
Zip Code:
Summer Address
Street:
City:
State:
Zip Code:
Send Billing / Grades To:
Telephone Numbers / Email
Day:
Evening:
Summer:
Email Address:
I wish to register for the following summer session courses: (Include beginning / ending dates of courses. Check course descriptions for pre-requisites. Workshops must be registered on the campus offering the workshop.)
Course One: Session Dates Synonym Number Dept/Course Number Section Course Title Credits Course Two: Session Dates Synonym Number Dept/Course Number Section Course Title Credits Course Three: Session Dates Synonym Number Dept/Course Number Section Course Title Credits
I am currently a student at:						College / University
Have you registered for a course at Clarke University before?

I expect to receive veterans' benefits:

Clarke University Students: Has your academic advisor and/or chair approved this registration?

Other Students: Please submit application and transcripts to Clarke University Graduate Studies Office, 1550 Clarke Drive, Dubuque, Iowa, 52001-3198.
Signature of Registrant: Date:
Registration is not official unless student types their name above or signs the printed registration form agreeing to the regulations stated in the summer school schedule.

Summer Sessions